Healthcare Provider Details

I. General information

NPI: 1952495525
Provider Name (Legal Business Name): JODIE BEMBRY WADE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 MEDICAL PARK LOOP SUITE 503
SYLVA NC
28779-5222
US

IV. Provider business mailing address

186 MEDICAL PARK LOOP STE 503
SYLVA NC
28779-5275
US

V. Phone/Fax

Practice location:
  • Phone: 828-586-7994
  • Fax: 828-586-7940
Mailing address:
  • Phone: 828-586-7994
  • Fax: 828-586-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201010
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: